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1. Iermit Number:
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i • i APPlication
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i • . . . • • •unty License— r ,►
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DESIGN ERJENGINEER: Not ApplicableMORTG GE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip:- Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylai vs or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review yoi ir deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree t iat I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie ie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement m ist be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Si atur/oOwn er/Lessee Contractor for Owner signature -of ntractor/License Holder"'—
STAT OF FLORIDA STATE OF FLORIDA
COUNTY OF /�/Ilffl—i�fL COUNTfOF
The forgo��ing instrument was acknowledgedhefore me The forg Ing instrum was acknowledged before me
this[��qday of ��GI.��O�.20 by this ay of 0J 20 JQby
(Name of person acknowledging) (Name of person acknowledging)
I
(Sign re of Notary Public-State of Florida) (Sign a of Notary Public-State of Florida)
Personally Known `✓ OR Produced Identification Personall Known L-""" OR Produced Identification
Type of Identification Type of I entification
Produced Produce
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED JUSTIN DAVID N"""" JUSTIN DAVID CONE ,lar►�'"•.:
orlda
ev. Notary Pu Ic-State o °�. i - tate of l 19
Commission M GG 196519 o Commission k GG r 14,2
My Comm.Expires Mar 14,2022 dor F,ot My Comm.Expires Mar 14,2022
Bonded through National Notary Assn. Bonded through National Notary Assn.